The Bizarre Double Life ofDr. William Stewart Halsted

GENIUSON THE

EDGE

GERALD IMBER, MD

This publication is designed to provide accurate and authoritative information

in regard to the subject matter covered. It is sold with the understanding that

the publisher is not engaged in rendering legal, accounting, or other professional

service. If legal advice or other expert assistance is required, the services of a

competent professional should be sought.

© 2010 Gerald Imber, MD

Published by Kaplan Publishing, a division of Kaplan, Inc.

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New York, NY 10006

All rights reserved. The text of this publication, or any part thereof, may not

be reproduced in any manner whatsoever without written permission from

the publisher.

Printed in the United States of America

10 9 8 7 6 5 4 3 2 1

Photographs reprinted with permission of the Alan Mason Chesney Archives

of The Johns Hopkins Medical Institutions.

Library of Congress Cataloging-in-Publication Data

Imber, Gerald.

Genius on the edge : the bizarre story of William Stewart Halsted, the father

of modern surgery / by Gerald Imber.

p. ; cm.

ISBN-13: 978-1-60714-627-8

ISBN-10: 1-60714-627-4

1. Halsted, William, 1852-1922. 2. Surgeons—United States—Biography. I. Title.

[DNLM: 1. Halsted, William, 1852-1922. 2. Physicians. 3. Biography.

4. General Surgery—history. 5. History, 19th Century. 6. History, 20th Century.

WZ 100 H1962I 2010]

RD27.35.H36I43 2010

617.092—dc22

[B]

2009035525

Kaplan Publishing books are available at special quantity discounts to use

for sales promotions, employee premiums, or educational purposes. For more

information or to order books, please call the Simon & Schuster special sales

department at 866-506-1949.

“Surgery would be delightful

if you did not have to operate.”

W. S. Halsted

Contents

Prologue ix

One Tumultuous Times 1

Two Setting the Stage 9

Three Physicians and Surgeons 21

Four Becoming a Surgeon 29

Five New York 37

Six Cocaine 47

Seven The Visionary 59

Eight The Very Best Men 75

Nine Baltimore 85

Ten The Hospital on the Hill 95

Eleven Finding the Way 101

Twelve William Osler 105

Thirteen The Operating Room 111

Fourteen The Radical Cure of Breast Cancer 117

Fifteen Life in Baltimore 127

Sixteen The Big Four 139

Seventeen Hernia 145

Eighteen Establishing the Routine 155

Nineteen Country Squire 167

Twenty The First Great Medical School 183

Twenty-one Teaching without Teaching 189

Twenty-two Residents 193

Twenty-three Changes 205

Twenty-four Into the 20th Century 221

Twenty-five Harvey Cushing 229

Twenty-six All Quiet on the Home Front 247

Twenty-seven After Cushing 257

Twenty-eight New Horizons 267

Twenty-nine Addiction 277

Thirty Vascular Surgery 283

Thirty-one Scientist 287

Thirty-two A New Paradigm 297

Thirty-three A New Era 307

Thirty-four The World Changes 321

Thirty-five “My Dear Miss Bessie” 331

Thirty-six The Final Illness 341

Thirty-seven Afterward 345

Epilogue 353

Acknowledgments 357

References 359

Index 375

About the Author 389

ix

Prologue

APRIL 1882.

Fresh, white sheets were brought down from the linen cupboard

and laid over the kitchen table. A down pillow was placed under the

head of the jaundiced 70-year-old woman. She was febrile, nause-

ated, crippled with abdominal and back pain, and clearly in extremis.

Dr. William Stewart Halsted carefully examined his patient, working

his way to an inf lamed mass on the right side of her abdomen just

beneath the rib cage. Pressing his fingers against it, he caused the

woman to jerk away and cry out.

For more than a year, she had complained of a sour taste in

her mouth, loss of appetite, and episodes of sharp pain penetrating

through to her back, symptoms that confounded the finest consul-

tants in New York City. Now, while the woman was visiting with her

daughter in Albany, the pain had become unrelenting. The onset of

high fever; rapid, shallow breathing; and the yellow cast of her eyes

made those attending her fear for her life. A telegram had been sent

summoning Dr. Halsted, who arrived by train from New York late

that same evening.

By 2 a.m. the septic patient was on the kitchen table and prepared

for surgery. What had been an elusive diagnosis was now clear: acute

cholecystitis (an infection of the gallbladder); empyema (a collection

of pus in the distended gallbladder); and gallstones, which blocked

the egress of the bile and pus. Halsted realized that nothing short

of emergency surgery could save the patient’s life.

x

Prologue

THE INSTRUMENTS HE brought with him were boiled and dipped

in carbolic acid. He rolled his coat sleeves above his wrists, washed

his hands with green soap, dipped them in the carbolic acid, and

approached the patient, who was now breathing ether fumes and

unaware of the impending surgery. With a scalpel in his bare hands,

he cut through the tense skin and subcutaneous fat above the hot

mass, then swiftly through rectus abdominus muscle and the perito-

neum lining the abdomen, exposing the enlarged, pus-filled gallblad-

der. Halsted incised the inflamed organ, releasing a f lood of purulent

material and seven gallstones. He clamped the bleeding points with

artery forceps and tied them off with fine silk ligatures. He closed the

peritoneum and re-approximated the abdominal muscles. The skin,

and the fat beneath it, were left open and packed with cotton gauze.

RELEASING THE ACCUMULATION of pus and removing the gallstones

effectively relieved the acute problem. The patient recovered unevent-

fully and was symptom free for the remaining two years of her life.

William Stewart Halsted had successfully performed the first known

operation to remove gallstones, and in the process had brought his

mother back from the brink of death.

�

1

Chapter One

Tumultuous Times

WILLIAM STEWART HALSTED WAS born in New York City on

April 23, 1852, in the decade of booming mercantile prosper-

ity and civic unrest preceding the Civil War. Immigrants seeking to

escape famine and poverty in their native lands poured into the city

at an astounding rate, often as many as 250,000 in a single year. The

new arrivals, then largely Irish, supplanted free blacks as an inex-

pensive labor source, and the slums were soon overrun. Only half the

children born in the entire country would live to the age of five. More

New Yorkers were dying from disease each year than were being born.

Two cholera epidemics in the 1830s and 1840s had claimed thousands

of lives, while earlier outbreaks of malaria and yellow fever had taken

many more. Within the filthy slums, especially the notorious Five Points

neighborhood, about which Charles Dickens said, “All that is loathsome,

drooping and decayed is here,” the death rate was three times that of the

rest of the city. Without the new immigrants, the population of the city

would have been decimated. With them, the city was almost unlivable.

Tuberculosis was rampant. It was a scourge of greater proportions

than AIDS, influenza, and polio combined, and had run unchecked for

centuries, killing hundreds of millions of people worldwide. The disease

was not limited to the lung infection, or consumption, immortalized

GENIUS on the EDGE

2

in literature by Dumas’s Marguerite in Camille, and later Violetta in

Verdi’s La Traviata. It was a generalized condition that also produced

draining scrofulous abscesses of the lymph glands of the neck and

axilla, and bone infections necessitating amputation. Little could be

done other than drain the tumors and remove the festering parts.

Rich and poor lived in close contact, and resentment and unrest

were everywhere. Riots in the first half of the century were common

and usually reflected class and ethnic hostilities. Among these were

the deadly Astor Place Riot in 1849 and the Klein Deutschland Riot of

1857. Earlier riots had erupted between Catholic and Protestant street

gangs, and several were prompted by the city’s efforts to remove some

20,000 feral pigs from city streets.

As mid-century approached, the gentry abandoned lower Man-

hattan and moved “uptown” to the wide-open spaces of Greenwich

Village. Among them were the prosperous Halsteds.

By mid-century, 14th Street had become the epicenter of society.

Broadway was the busiest shopping corridor in the world, and 200,000

horses plied the city streets, pulling stagecoaches, buses, delivery wag-

ons, and cabs. Sanitation was nonexistent and health hazards were

overwhelming. Each horse produced more than 15 pounds of manure

daily, and there was no organized system for its disposal. Manure piles

were everywhere, seeping into street-level rooms in heavy rain, drying

in fly-infested piles in summer. Each year, 20,000 horse carcasses were

dragged from city streets to the pier on West 38th Street to be shipped

to rendering plants in Barren Island, Brooklyn, where the bones were

turned into glue. New “brownstone” homes were built with high entry

stairs to avoid the ubiquitous manure.

Human excrement was also a problem. There was no municipal

sewer system, although more aff luent neighborhoods could petition

for the construction of sewers and share the cost among the residents.

Elsewhere, chamber pots were still emptied from tenement windows

into the street. Women used parasols to protect themselves and their

3

Tumultuous Times

finery from flying excrement. The exodus uptown provided some relief,

but it wouldn’t be until after the turn of the next century that electric

buses and the automobile supplanted horses and eased the situation.

In the late 1830s, a professor of art at the University of the City

of New York named Samuel F. B. Morse designed the first operable

telegraph. Less than a decade later, private telegraph companies

turned New York into a communications hub with lines connecting

the nation. Financial institutions relished the quick transfer of infor-

mation available in Manhattan, and the industry found a permanent

home in the growing financial district around Wall Street.

By 1860, there were 30,000 miles of railroad track connecting the

country. As railroads expanded westward, a key link opened along the

route of the Erie Canal connecting the Great Lakes and the Atlantic

Ocean. Manufacturing and transportation prospered. The Croton Dis-

tributing Reservoir was built far uptown, at 42nd Street and Fifth Ave-

nue. A massive structure on a four-acre site, which is now home to the

main branch of the New York Public Library, the reservoir held 150 mil-

lion gallons of pure upstate water for the thirsty, growing city. Nearby,

the Crystal Palace, a monumental exposition hall of cast iron and glass,

was opened in the summer of 1853 to house the first World’s Fair in

America. Music and entertainment venues sprouted all over town. The

city was in thrall to Jenny Lind, the “Swedish Nightingale,” who was on

a two-year tour promoted by P. T. Barnum. Tickets to her performances

sold for as much as $650 at auction. Stephen Foster’s popular songs,

such as “Oh Susanna!” and “Camptown Races,” were perennial favorites.

Some, such as “My Old Kentucky Home, Good-night,” stirred sympathy

for the plight of America’s slaves even as most northern blacks, while

free, had achieved nothing close to equality.

The Halsted family had lived in and around New York City since

the 1657 arrival of the Englishman Timothy Halsted in Hempstead,

Long Island. By the mid-18th century the next generation of Halsteds

had moved to Elizabethtown, New Jersey, where Robert and Caleb,

GENIUS on the EDGE

4

the first physicians in the family, were born. Robert’s son, William

Mills Halsted, did not follow his father’s calling and instead, with a

partner, R. T. Haines, founded Halsted, Haines and Company, deal-

ing in the wholesale importation and sale of dry goods. The firm

was immediately successful, and the family was soon entrenched in

the prosperous mercantile society of the city. William Mills Halsted

became an elder in the University Place Presbyterian Church, a gov-

ernor of the New York Hospital, which was then located at Broadway

and Pearl Street, and a founder of the Union Theological Seminary. He

also invested heavily in the rapid development of Chicago; the longest

thoroughfare in that city is still called Halsted Street.

The family fortune grew, and in 1835 William Mills Halsted built a

large, finely appointed home on the northwest corner of Fifth Avenue at

14th Street, soon adding three adjoining houses for his children. He was

a picture of Presbyterian rectitude, constantly preaching to his children.

One of his children, Thaddeus, became a physician. To another, William

Mills Halsted Jr., then away at school, he wrote, “endeavor my son to

qualify yourself in usefulness and responsibility.” Young William learned

his lessons and succeeded his father at the helm of Halsted, Haines

and Company. He was a founder of the Commonwealth Fire Insurance

Company, joined the board of governors of the New York Hospital and

Bloomingdale Asylum, the board of the College of the City of New York,

and the board of the College of Physicians and Surgeons. William Mills

Halsted Jr. married his cousin Mary Louisa Haines, and together they

raised a family in New York City, summered at Irvington, 25 miles north

along the Hudson River, and were pillars of the community.

Frugal and strict, William Mills Halsted Jr. adhered closely to his

father’s Presbyterian ethic and demanded the same of his four chil-

dren. Though he provided well for his children, he forbade them to

bring friends to their home for meals. When his youngest son, Richard,

disobeyed this rule, he presented Richard and his friends with a

detailed bill for the food they consumed.

5

Tumultuous Times

William Stewart Halsted was the eldest of the four children. Until

the age of ten he was homeschooled by governesses, then a common

practice among the aff luent. Public education in New York City was

inadequate, and those of means sent their older children to the numer-

ous private institutions throughout New England, most of which had

close church ties.

The Halsted family remained seemingly untouched by the Civil

War raging in the South. In the summer of 1862, just a few months

after the Battle of Shiloh claimed the lives of 24,000 Union and Con-

federate troops, William Stewart was sent off far from the fray, to a

school at Monson, Massachusetts, run by a retired Congregational

minister, the Reverend Mr. Tufts.

It was an unpleasant experience, and Halsted later wrote:

There were about twenty boys in the school, all much older

than I. I can recall very little of the method of instruction, but

I must have studied Latin for I was given the choice of learn-

ing a lesson in Latin grammar or stirring soft soap in a great

cauldron on Saturday afternoon when I was kept at home for

misdemeanor, usually for swimming in the river. Sunday was a

nightmare: we were driven to church two miles away and spent

the entire day in the churchyard — Sunday school from nine

to ten or ten-thirty, church until 1 p.m. luncheon from basket,

Sunday school again at 3 p.m. and church say from four to five-

thirty. In the spring of 1863 I attempted to escape, walked to

Palmer, four miles, took train to Springfield twenty miles; was

captured at Springfield and taken back to Monson.

In July 1863, the Draft Riots, the bloodiest riots in American his-

tory, were ignited at a conscription office on 47th Street and Third

Avenue when poor Irish protested a new law that allowed anyone to

buy their way out of military service for $300. The violence soon took

GENIUS on the EDGE

6

on racial overtones, and many blacks were targeted and hanged. Over

five days the mayhem claimed as many as 1,000 lives.

That fall, young Halsted, kept safe from all of this, was enrolled

at Phillips Academy, a preparatory school in Andover, Massachusetts,

north of Boston. The school, founded in 1778 by Samuel Phillips, is more

commonly known as Andover, distinguishing it from its rival Phillips

Exeter Academy, in Exeter, New Hampshire, founded three years later

by another family member, Dr. John Phillips. The Phillips Academy,

Andover, is rich with American history. Its great seal was designed by

the silversmith Paul Revere. Two of its many distinguished graduates

were telegraph inventor Samuel F. B. Morse and U.S. Supreme Court

Justice Oliver Wendell Holmes. From its earliest days, Andover estab-

lished a tradition of preparing its young men for enrollment at Yale.

In 1868, of a senior class of 40 students, 25 went on to continue their

studies in New Haven.

Even at this early stage of his life, Halsted was careful about his

dress and always well turned out. A photograph from the period shows

a good-looking young man in suit, waistcoat, and matching cravat — his

blond hairline already rather high on his forehead, and prominent patri-

cian nose turned up at a fairly high angle over a wide, smiling mouth

and full lower lip. His ears stood smartly away from his head, a feature

about which he was often teased. Later in life he defused comments by

joking about his ears before others could call attention to them. Barely

five feet six inches tall, Halsted was solidly built, with a surprisingly

muscular upper body and a tendency to walk with his elbows out.

Not yet 17 years old at graduation in 1869, and thought too

young to enter college, he was enrolled in a private day school in

Manhattan and tutored privately in Latin and Greek prior to college

entrance exams. Halsted was admitted “without condition” to Yale,

along with numerous of his Andover classmates. At Yale, “[I] devoted

myself solely to athletics,” and his grades were in no way equal to

his athletic achievements. Andover boys were well prepared for the

7

Tumultuous Times

first few semesters at Yale, and it set them off with a relaxed attitude

toward college education.

Athletics remained central to his life. He joined the junior and

senior class crews, was shortstop on the junior class baseball team, and

in his senior year served as captain of the football team. This was the

first year of modern, 11-man football in college athletics. The 160-pound

Halsted also knocked his friend Sam Bushnell f lat in a boxing match.

There is no record of Halsted ever having borrowed a book from

the Yale library.

The class at Yale was organized into four academic divisions

based on performance. Halsted spent most of his lackluster tenure

in the second and third divisions, although classmates believed he

could easily have been in the first had he cared. Finally convinced

to apply himself to his studies, he worked hard and did well on mid-

term exams. He abandoned the second division and assumed what he

believed to be his rightful place attending first-division classes. Not

finding himself registered among the division-one students, his irate

inquiry was met by an instructor informing him he had been placed in

the third division. The lesson that a perception once formed is difficult

to alter was one he learned well.

Notably well dressed at Yale as he had been at Andover, Halsted

and a friend paraded around campus for a time in tailor-made suits of

mattress ticking. Sam Bushnell believed the outrageous fashion state-

ment was clearly a Halsted prank, but “he did not have the courage to

carry out his idea alone.”

Halsted was a member of a number of college clubs including the

Freshman Society, Freshman Eating Club, The Tasters, The Sopho-

more Society, Phi Theta Psi, the Junior Society, and Psi Epsilon. But

only inclusion in the elite senior society, Skull and Bones, mattered

to him. His father had been a member and had aggressively pushed

his son to seek election. The society seemed so important to him that

Bushnell offered to decline election if his friend was excluded, but

GENIUS on the EDGE

8

Halsted refused: “If you get an election, you take it; if I get an election

I shall take it. I shall expect you to do the same by me.”

In the end, he was not tapped for the society. The rejection was all

the more devastating since his “Bonesman” father did not take it well,

saying to Bushnell, “Why didn’t you get him into Skull and Bones?

You made it.”

Halsted acted in plays, “did not go in for social activities,” and did

not drink. There is no mention of girls in any of Halsted’s letters or

reminiscences, or in the comments of friends. He continued to attend

church regularly while at school but was increasingly dismissive of

the strict religious fervor of his parents. The trip to New York was

fast and convenient on the New Haven Railroad, and he came home

frequently during the school year. He visited with the families of col-

lege friends and made several trips to Baltimore with his friend Henry

James, son of a leading local financier. Summers were spent at the

family home at Irvington, in the lower Hudson Valley, and the four

children remained close with their parents and one another. Several of

the family members were avid gardeners, and this became a passion

that William Stewart shared as well.

In a totally uncharacteristic act early in his senior year, the

unscholarly Halsted purchased copies of Gray’s Anatomy and Dalton’s

Physiology. He had shown no interest in science previously, but now

immersed himself in the reading. He spent his free time around the

laboratories and clinics at the Yale medical school, asking questions of

anyone who would speak to him. As his time at Yale came to a close,

young Halsted told his father that he was not interested in joining the

family business but would like to study medicine. It was a decision

that would change the face of modern medicine.

�